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The Supreme Court is now weighing the constitutionality of a provision of the federal health care law that would vastly expand Medicaid. An estimated 17 million Americans who don't qualify for the health benefit program for the poor now will, beginning in 2014.
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The law also offers states a chance to start expanding their Medicaid programs before then, and a handful are.
Eric Whitney of Colorado Public Radio explains how that state is adding people to Medicaid in tough budget times.
ERIC WHITNEY, BYLINE: You don't have to spend much time on the streets of downtown Denver before you run into someone selling a newspaper called The Homeless Voice. Guys like Dale Miller. He's been having some health problems and can't really afford to see a doctor on the 10 to 15 bucks a day he makes selling papers. But a local charity clinic recently helped him get a CAT scan at no cost to him.
DALE MILLER: I've got my itemized bill in my backpack and it was like $450 for the doctor, it was $1,100 for the lab work. And the state is paying for that.
WHITNEY: The state's actually only paying for a small part of those bills. Colorado has an indigent care program that helps charity clinics and hospitals that get stuck with bills like Miller's, but it only pays about 10 cents on the dollar.
Now, that's starting to change. Colorado Medicaid director Suzanne Brennan says the state is starting to help some of Colorado's poorest residents enroll in Medicaid.
SUZANNE BRENNAN: We have never done that in the past, so this is definitely a new foray for us into this area.
WHITNEY: Like most states, Colorado has limited Medicaid enrollment, only covering poor kids, pregnant women, the disabled and some elderly. That's because the federal government offers states a dollar-for-dollar match to help cover those populations, but nothing for adults without kids. So most states don't cover them, no matter how poor they are.
But the 2010 federal health care law now extends that federal match to help states cover adults without kids. Colorado's now the seventh state to take advantage of it. It's spent years crafting a way to come up with its share of the match.
BRENNAN: We passed legislation that allowed us to do this and it's related to the hospital fees, so we actually have the funding to offer this for the first time.
WHITNEY: Colorado hospitals volunteered to pay this new fee into state Medicaid and that money pulls in federal matching funds that now allow the state to offer Medicaid to more people. It's a win for the hospitals because more people on Medicaid means fewer unpaid hospital bills, but the combined funding still isn't enough to cover every adult in Colorado below the federal poverty level, even though Brennan says that was original plan.
BRENNAN: We did research around the country to understand this population and, based on what we know are their needs, we've reduced the number of people who would be eligible for this program.
WHITNEY: They reduced it by a lot, capping enrollment for now at 10,000 people. That's less than 10 percent of adults below the poverty line in Colorado. That's because the state expects them to rack up bills twice as high as the average Medicaid recipient. It expects higher bills because poor people without insurance typically don't go to the doctor as often as people with coverage. They may not see a doctor at all until their conditions become dire.
Dr. Marti Shulte treats a lot of people like that at the Colorado Coalition for the Homeless' clinic in Denver.
MARTI SHULTE: The complications I see in a 45-year-old, I might not have seen in private practice.
WHITNEY: Complications like...
SHULTE: Like amputations or foot ulcers from diabetes or renal disease in a diabetic who's 43 instead of what I might have seen in somebody who's 60 or 65.
WHITNEY: Colorado and the Obama Administration say that giving Medicaid to more people will mean they can avoid expensive complications like that because it'll cover primary care to help people stay healthy in the first place.
But Republicans are fighting Medicaid expansion at both the federal and state level. Colorado GOP State Senator Shawn Mitchell says it's just too expensive.
STATE SENATOR SHAWN MITCHELL: The state can't afford it. The economy can't maintain it and we're just lying, telling people that we can cover everything that we've put on paper that we'll cover.
WHITNEY: Democrats say America can afford the huge Medicaid expansion in the 2010 federal health law and that it'll actually save money long term. That's if the Supreme Court doesn't strike it down.
Meanwhile, Colorado is going forward with its own limited expansion. It's taking applications for it until mid-May and then will hold a lottery to choose 10,000 people to get the benefits.
For NPR News, I'm Eric Whitney in Denver.
BLOCK: And that story is part of a partnership with Colorado Public Radio, NPR and Kaiser Health News.